Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5-2.0cm in diameter

Abstract

Purpose To evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of upper ureteral impacted calculi (1.5cm to 2.0cm in diameter). Methods From December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates were compared between the two groups. Results A total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p=0.067, 0.198).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81±18.94minutes vs FURSL 86.80±22.49minutes, p=0.0004), fewer complications(PCNL 20.37% vs FURSL 6.12%), and lower postoperative inflammatory factor（p=0.0004）, yet they got more hemoglobin drop（PCNL 13.14±9.81g/L vs FURSL 4.77±3.55g/L, p<0.0001）, higher postoperative pain scores (p=0.0017) in the first three postoperative days. Conclusion Both FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5-2.0cm in diameter given that there was an extremely high stone clearance rate and a very low secondary surgery rate. While PCNL effectively reduced operative time, postoperative inflammatory factor and the risk of postoperative complications, it had more hemoglobin drop and postoperative pain scores comparing with FURSL.